Permit ELECTRICAL PERMIT
CITY OF TIGARD =
PERMIT #: ELC2007 -00613
COMMUNITY DEVELOPMENT DATE ISSUED: 9/4/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 104AD -01800
SITE ADDRESS: 12655 SW 128TH AVE ZONING: R -4.5
SUBDIVISION: BELLWOOD LOT : 045 JURISDICTION: TIG
PROJECT: CONNOR
Project Description: Grounding for new water service.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA /SPEC OCC:
Owner: Contractor:
CATHLEEN CONNOR BRIDGETOWN ELECTRIC
12655 SW 128TH 22732 NW GILLIHAN ROAD
TIGARD, OR 97223 PORTLAND, OR 97231
Phone: 503 - 579 -8693 Contact #: PRI 503 - 621 -7122
FAX 503 - 621 -7123
FEES
Description Date Amount Reg #: ELE 26 -887C
[ELPRMT] ELC Permit 9/4/2007 $46.85 LIC 103824
[TAXI 8% State Surcharge 9/4/2007 $3.75 SUP 4177S
Total $50.60 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws, All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100 ou may obtain .pies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
1 /
Issued L _ Permittee Signature: /11-1)0 ( ca, --F( cyr)
OWNER INSTALLATION ON
LY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
•
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FIug 31 2007 10:21FAM Bridgetown Electric 503 - 621 -7123 p.1
` t. f Electrical Permit Applies 'e D FOR OFFICE LSE ONLY
City of Tigard „ Received
Date/B . El l L Permit No.: LG d w- ii 0
13125 SW Hall Blvd.. Tigard, 0 P n 1 e , w
Phone: 503.639.4171 Fax: 50359 &1960 foots - ` •' I I • DateB Other Permit p / . -, A
Inspection Line: 503.639.4175 U � D ___ _ `'I � „ Date Ready/By:
FM la
See Page 2 for
,, Internet Www.Ci.tigard.or.uS - -` \Gf +r dfied/Medtod. Supplemental information
; - ., 4 - r :• - - n,7ig .z. 64 ';=^*''- !rr � :s:7::::;1:-7.' % .: re •. �N: lti',> f ;fir
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❑ New construction I! near q? alteration/replacement Please check all that apply:
❑Service over 225 amps, comm'l ❑Hazardous location
❑ Demolition ❑ Other.
VD „rt l . r r - A ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. it.,
.. -, 4 , ,� 4 n t Nk a . iv: gg.i.. ; ' v. w fi of 1- and 2-family dwellings 4 or more new residential
Li - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
❑ Multi - family 0 Master builder ❑Other
❑Occupant load over 99 persons ❑Manufactured structures or
a 31t 4 .. � " rt¢ `' �- 1 '". ❑ gh ngP � RV park
w:. h '.�.lF3v�'o wtiShr+ e.T'� �;"„x:"�."'°.. Kl.:.� � " dSfrx ;� ., s
Job no.: -- 16 - 34 4 4 , Job site address: 1 '2.. (.B 5 SW ' a 8 sf ❑ Health -care facility ['Other
Submit 2 sets of plans with any of the above.
City /State/ZIP: 'ri c) (t.-04-- The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: 1 Project flan= h V) a � - ` ;mss , :ie . } %: :; t::: ..
Description Qty. Fee Total .
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft_ or less - - - - "115.15 _ _ - 4
Subdivision: ( Lot no.: Ea. add'l 500 sq. ft. or portion 33A0 1
Taxnag /parcel no : Limited energy. residential 75.00 2
5� o.. ' g r n« t . ` Limited energy, non - residential 75.00 2
. +; ` "� � �� 3 , a:. rc =,, -� ; R ' • . + to . i i 1:1>'.‘,.2.' » ^�, Each tnanufacmred or modular
{ v 67J i1 L. f / t-., `'t` -44_, �3-r /�' .5"e�f, UL.
dwelling, service and/or feeder 90.90 2
( ` 7'id Services or feeders installation, alteration, and/or relocation
.A /'rd f 'OS . PG 4P/ a s /tr 7 ,• E as - 200 amps or less 80.30 2
t v Fi r may " - 201 amps to 400 amps 106.85 2
I?d 1 rat. R '�A C� 6 �'�" fp a , . '. .-,- ., cAk " - " _,x.', ' 'c : ° .
e,::- ...�k ._ fr.r . - 3 � C. C'. �x° t 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZT)?: Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
amps or less 66.85 ' 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133 - 75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
ift: t '7 aiF ;f f ,-, „ " t st . r 1� . i ' is l I4 A- Fee for branch circuits with
r a a 1 r ., ;e -.e. :k'Zi?izk c 4 il,4117< iaat oss4§ti h ' : `3p1it
�1 r J p� service or feeder fee, tech 6.65 2
Business name: C JL �} l� �- T .,_ (f branch circuit
/ B. Fee for branch circuits
Contact name: L_ yi ) f '�'�S l.t j�
� without service or feeder fee, 46.85 2
each branch circuit
Address: ,7.? -) 3 a- ! �vt t to 1(1 ( >l, 151 Each add'l branch circuit . - -- - ; 6.65 2
City /State/ZIP: ' P(j'irs y . . (i.- Ch 01- Misceaaneons (service or feeder not included)
Phone: ( ) (i24 71 e)-'- ! I Fax: : (15 ) ( 71 a-�i Pump or irrigation cycle 53A0 2
Sign or outline lighting 53.40 2
B • -{-e a t.,06 etc[ }ralr C4 li-- Signal citcuit(s) or limited- - I
g 'c x Z '. s °-a il,: s £ W; , ,� '�°{ u, a-,,- / 5 1 3 , _> ss �xy3E'.- S ' Fg'�zra: j , ' _6 e el alteration, o?
$"ui�.- � . -F.;R� '= �.r i£•E,.s4�<it� i F w'" , c 1 f.�i:- ,4= .Cr,�'?i'se :wZ e
,.p w l �,, . extension. Descnlre: Page 2 2
Business name: , Ir j {;�qc -1- 11, ef vi c-
Address" `1 i i I t 1 7( i karat Each additional inspection over allowable in any of the above
o� tV W tl+ llO Per inspection 62.50
City/State/ZIP: ,}f. - - L t k i f io-3 Investigation per hour (t brain) 62.50
Phone: 3) ( F f ,y _ l I Fax: (:50 2j) (PG � - - 7 ( ,P_3 industrial plant per hour 73.75
CCB Lie -: � 7� Z4' Electrical Lic.: 2.(p' k7 C I Suprv. Lie.: l; -1 '11 5 Subtotal . S
Suprv. Electrician signatUe, ed: Plan review (25% of permit fee)
Print name: Kern - .6e n S {Z t I Date: r . ) ,..---) G State surcharge (8% of permit fee) 3 7 5
TOTAL PERMIT FEE S 6 . G 0
Authorized Si Y. -- • ' - 7 This permit application expires if a permit Is not obtained within 1 SO
! -, i' - - .al - '..:e..e... !�-- days after it has been accepted as complete
Print name: .. ■ Date: • Fee methodology act by Tri Building Industry Service Board
I
CITY OF TIGARD . .
BUILDING DIVISION PERMIT #: ELC2007 00613
AR 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/4/2007
Phone: (503) 639 -4171 1.1 rl
Inspection Requests (24 Hrs.): (503) 639 -4175. __ ='I I..
INSPECTION WORKSHEET FOR DATE: 9/13/2007 TIME: 7 :01AM PAGE: 64
SITE ADDRESS: 12655 SW 128TH AVE CLASS OF WORK:
SUBDIVISION: BELLWOOD LOT #: 046 TYPE OF USE:
. PROJECT NAME: CONNOR
DESCRIPTION: Grounding for norm water service.
OWNER: CONNOR, CATHLEEN PHONE #: 503-679-8693
CONTRACTOR: BRIDGETOWN ELECTRIC PHONE #: 503.621 -7122
Inspection Request Scheduled For: Date: 9/13/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 065442 -01 503. 621 -7122 V
. ' l /LIo — / - �iW 7/i7
Corrections /Comments /Instructions:
C -j ea A/P i � ,'t � L
E
L. i,v/0- ,
R PASS n PARTIAL APPROVAL I I CANCEL I I NO ACCESS
H FAIL CALL FOR INSPECTION I I ADDITIONA FEES ASSESSED
Inspector: 6 ' l�l 0 Date: • 0 Phone #: (503) 718 -